Peoples of Persian culture celebrate the last Wednesday of the year on its eve, the Tuesday night, according to the Persian calendar. Named Chaharshanbe-Soori, literally ‘red Wednesday', the festivity is held on a day from 12 to 19 of March. The event precedes Nowruz (the Persian New Year) and comprises several traditions of which setting up bonfires and jumping over them is an integral part. Red refers to fire, itself symbolizing brightness, purity, life, and health in ancient Persia.1 The origin of the festivity goes back to a Zoroastrian tradition circa 1725 BC.

Fireworks are used in many celebrations around the world: the Fourth of July (the United States’ Independence Day), the New Year in China, Halloween and Guy Fawkes Night in the UK, Diwali in India, Hari Raya Festival in Malaysia, and Prophet Mohammad’s Birthday in Libya.2-7

In today’s Iran, the original ceremony of bonfires has been transformed into a social bedlam in the big cities in which a wide variety of illegal and hand-made firework agents are being used. The situation is being further complicated by the fact that the government does not recognize the celebration as a legitimate national festival in a contrast to similar such ceremonies in the world (including Iran) in which fireworks are being organized as public displays managed by professionals wherein civilians attend to in the form of spectators the role of children and the young is kept limited and the usage of firework agents is highly regulated.

Use of hand -made and unconventional devices or explosives create frequent burns and injuries. Hands are the most common place of injury (up to 53%)8-10 followed by eyes (up to 27%) which also sustain the most serious ones.8 An even uglier aspect is that the injury affects bystanders or passersby too. In fact, it has been shown that the severity of injury is even worse in this category.11

Based on various reports, more than 10% of the casualties need hospitalization and surgical care.13,14 But, the frequency of severe injuries is not limited to inpatient admissions: some eyes sustain devastating intraocular damage despite an intact globe from angle recession to traumatic cataract and retinal detachment to traumatic optic neuropathy.12 {Appendix Table 2}

On rare instances, firework agents have caused extensive burns and scarring,16 amputations of the extremities,15 intracranial injury,17 and even death (due to extensive burn or massive explosions).9 Frequently, severe injuries of the eyes cause monocular blindness: up to 10% of the injured eyes.20 The expression ‘ fireworks blindness’ is being used in order to create awareness over this potential risk.21 Additionally, disfigurement of the external eye happens not infrequently adding to the morbidity. Enucleation and/or no light perception are estimated at 1% in fireworks injury hospital series.13 The explosive nature of the injury, on rare occasions, has resulted in bilateral blindness.

Despite some publicized facts about this serious public health problem,18,19 it has largely been neglected in the scientific and policy circles. Currently, the injury constitutes a major contributor to (ocular) trauma in our country and the outlook over the elimination and control of the threat is not bright. It is expected that the clinicians provide the public and policy makers with information and advice on the issue. There is a need for more scientific contributions to the literature as the evidence on the magnitude and extent of the problem is limited.

Tables 1 to 3 of the Appendix list related eye injuries, present a severity ranking model, and organize a scheme for the study of such injuries. The descriptors and determinants cover clinical and epidemiologic aspects and are instrumental in related researches . Quantification of the severity of ocular trauma is important at least for two reasons: prognosis and characterization of risk factors of the more severe injuries for preventive purposes.

Nationwide studies are needed to estimate burden (in terms of burn and monocular blindness) and to determine risk factors. A national registry of hospitalized and/or severe cases is extremely helpful for surveillance of the phenomenon and in order to maintain awareness and to monitor trends remarkable variation in the frequency, severity, and profile of the injuries has been observed in the recent years. Description of the psychosocial picture and the adverse effect on quality of life is another important aspect. Case reports of unusual injuries are needed. Little is known about the long-term course of severe injuries. Sociologically-inclined studies should clarify alternative aspects of the phenomenon.

Iranian ophthalmologists' have an exceptional role as they are the most consulted on this issue. Prevent Blindness America states: ‘there is no secure way for nonprofessionals to use fireworks’. It further states: 'it is only safe to enjoy the splendor and excitement of fireworks at a professional display’.18 In a similar vein, I (SFM) believe that we, Iranian ophthalmologists, should embark on a more active public health advocacy that addresses public awareness, law enforcement, and provision of a healthy festivity alternative, i.e., professional public displays. This public health crisis recurring annually just prior to Nowruz is effectively forgotten till the next year. Such injuries—used to be a serious public health issue in the developed nations—should become a thing of the past in Iran too.